QAPI Program Utilization_Manual

UTILIZATION REVIEW PURPOSE: To review clinical records for the purpose of evaluating appropriateness, adequacy, and effectiveness of the offered. POLICY: · The Utilization Review (UR) Committee is a subcommittee of the QAPI Committee, which reviews a random sample of active and discharged patient record to determine whether policies are followed in providing services · The committee determines the appropriateness and adequacy of the services provided and reports its findings to the QAPI Committee. · In addition, the committee makes recommendations for needed administrative or supervisory action, in-service/education needs, and further program evaluation needs. PROCEDURE: · The committee will be composed of agency staff as well as other health professionals representing all disciplines providing service to agency patients. · The committee will meet quarterly to review records and evaluate findings · The committee will review a random sample of at least 10% of the caseload, over the entire year · Minutes of all actions and recommendations will be maintained · Reports of this committee’s work will be forwarded to the QAPI Committee for incorporation into the Quality Improvement reports for the Board of Directors. 39